1144576836 NPI number — COMMUNITY PHARMACY OF SMYRNA LLC

Table of content: (NPI 1144576836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144576836 NPI number — COMMUNITY PHARMACY OF SMYRNA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY PHARMACY OF SMYRNA LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CUSTOMHEALTH PHARMACY NASHVILLE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144576836
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 STONECREST BLVD
Provider Second Line Business Mailing Address:
STE 130
Provider Business Mailing Address City Name:
SMYRNA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37167-5688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-459-3007
Provider Business Mailing Address Fax Number:
615-459-5349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 STONECREST BLVD
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37167-5688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-459-5335
Provider Business Practice Location Address Fax Number:
615-459-5349
Provider Enumeration Date:
07/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GARRISON
Authorized Official First Name:
JANE
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANAGER CUSTOM HEALTH
Authorized Official Telephone Number:
407-857-2871

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 5062 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2158521 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com